1750401865 NPI number — ROSEN SERVICE GROUP, LLC

Table of content: (NPI 1750401865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750401865 NPI number — ROSEN SERVICE GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEN SERVICE GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GAIL ROSEN, LCSW COUNSELING, THERAPY & MEDIATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750401865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 N DE BAUN AVE
Provider Second Line Business Mailing Address:
APT 208
Provider Business Mailing Address City Name:
AIRMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-5125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-357-6797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 N FRANKLIN TPKE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
RAMSEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07446-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-785-8998
Provider Business Practice Location Address Fax Number:
201-961-8989
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEN
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-785-8998

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44SC05166900 . This is a "LCSW" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: R-070364 . This is a "LCSW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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